Reuse of dialyzers
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
- Section Editors
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
- Jeffrey S Berns, MD
Jeffrey S Berns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- Professor of Medicine
- Perelman School of Medicine at the University of Pennsylvania
Hemodialyzer reuse refers to the practice of using the dialyzer multiple times for a single patient. Dialyzer reuse appears to be a safe and cost-effective procedure for high-flux and high-urea removal dialyzers.
Reuse was commonly practiced in the United States during the 1980s through 1990s, largely for cost containment but also to reduce the incidence of inflammatory reactions due to blood-membrane interactions with bioincompatible cellulosic membranes [1-3]. The practice has markedly decreased since that time in the US, as has the use of bioincompatible membranes . In 2005, approximately 40 percent of dialysis units in the United States were thought to reuse dialyzers [2,3]. More recent data are not available, as the United States Renal Data System (USRDS) and the Centers for Disease Control (CDC) have stopped collecting information on re-use. Reuse is still commonly used in other parts of the world, particularly in countries with limited resources to dedicate to renal replacement therapies [4-6].
Only hollow-fiber dialyzers that are labeled by the manufacturer for multiple use are reprocessed . The methods used to ensure optimal performance of the reused dialyzer are best suited to hollow-fiber dialyzers (See 'Performance testing' below.)
This topic reviews methods of reprocessing hemodialyzers for reuse. Standards for hemodialysis, including water processing, are discussed elsewhere. (See "Water purification systems in hemodialysis" and "Contaminants in water used for hemodialysis" and "Maintaining water quality for hemodialysis".)
The basic procedure for dialyzer reprocessing involves four steps: rinsing, cleaning, performance testing, and disinfection and sterilization. Dialyzer processing may be performed manually or with the use of automated equipment. Most reprocessing in the United States is done using automated methods, which may be more reliable and predictable, though few good studies have compared methods. One study showed no significant difference in mortality between processing techniques when identical germicides were used . (See 'Clinical outcomes with reuse' below.)
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- REPROCESSING TECHNIQUES
- Performance testing
- Disinfection and sterilization
- - Chemical disinfection
- - Heat disinfection
- Inspection, labeling, and storage
- POTENTIAL RISKS
- Infection risk
- Loss of performance
- Germicide exposure
- POTENTIAL BENEFITS
- CLINICAL OUTCOMES WITH REUSE
- INFORMED CONSENT
- SUMMARY AND RECOMMENDATIONS